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Increased use of surgical energy promotes methicillin-resistant Staphylococcus aureus colonization in rabbits following open ventral hernia mesh repair

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Abstract

Background

Surgical energy has been widely implemented because of ease of use, effective hemostasis, and surgical dissection. Studies demonstrate its use to be an independent risk factor for postoperative wound infection. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common bacteria found in postoperative mesh infection. No reports are available on the sequelae of surgical energy use for open ventral hernia repair (oVHR) with mesh. We hypothesized that increasing amounts of surgical energy will result in higher infectious burden after oVHR with composite multifilament polyester mesh (Parietex™ PCO).

Methods

New Zealand rabbits underwent bridging oVHR with Parietex™ PCO and were divided into three surgical treatment groups: (1) scalpel alone, (2) 120 J of energy, and (3) 600 J of energy. The bioprosthesis was then inoculated with 105 colony-forming units of MRSA. Rabbits were survived for 7 days with daily physical examination. Complete blood count, basci metabolic panel, and blood cultures were performed on postoperative days one, four, and seven. Surviving rabbits were killed, and meshes explanted for MRSA colony counts.

Results

Rabbits receiving the most surgical energy developed signs and symptoms of severe sepsis and wound necrosis within 24 h. In comparison, rabbits receiving no surgical energy had significantly less MRSA recovered from explanted mesh, significantly less bacteremia, and fewer adhesions.

Conclusions

Increased use of surgical energy promoted greater colonization, exaggerated septic response to bacterial contamination, and more severe adhesions. In the absence of devitalized tissue, rabbits can effectively limit bacterial contamination. These findings support the surgical principles of proper tissue handling and highlight the detrimental effects of indiscriminant surgical energy usage, thus emphasizing the importance of programs such as Fundamental Use of Surgical Energy.

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Acknowledgments

This work was funded by the American Hernia Society Synovis Surgical Research Resident Grant FP00001306.

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Authors and Affiliations

  1. Department of Surgery, Houston Methodist Hospital, 6565 Fannin St., Suite 1660, Houston, TX, 77030, USA

    Joseph S. Fernandez-Moure, Jeffrey L. Van Eps, Bradley K. Weiner & Brian J. Dunkin

  2. Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA

    Joseph S. Fernandez-Moure, Jeffrey L. Van Eps, Lilia Peress, Leslie Jenkins, Fernando J. Cabrera & Ennio Tasciotti

  3. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA

    Concepcion Cantu & Randall J. Olsen

  4. Department of Orthopedic Surgery, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA

    Bradley K. Weiner

  5. The Methodist Institute for Technology, Innovation, and Education (MITIE), 6670 Bertner Ave, Houston, TX, 77030, USA

    Brian J. Dunkin

Authors
  1. Joseph S. Fernandez-Moure
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  2. Jeffrey L. Van Eps
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Correspondence to Joseph S. Fernandez-Moure or Brian J. Dunkin.

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Disclosures

Dr. Fernandez-Moure has funding from DSM biomedical for surgical applications unrelated to this work. Drs. Perres, Jenkins, Olsen, Cantu, Van Eps, Cabrera, Tasciotti, Weiner, and Dunkin have no conflicts of interest or financial ties to disclose.

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Fernandez-Moure, J.S., Van Eps, J.L., Peress, L. et al. Increased use of surgical energy promotes methicillin-resistant Staphylococcus aureus colonization in rabbits following open ventral hernia mesh repair. Surg Endosc 31, 852–860 (2017). https://doi.org/10.1007/s00464-016-5043-2

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